Back pain, the causes
Author: Dr David Brown, Doctor of Chiropractic and Clinic Director at Proback Clinics Surbiton, explains the causes of Back Pain.
Here is what you need to know: How common is back pain?, Why does backache occur?, Types of pain/What has failed?, Why does my leg/arm hurt?, Is the location of my pain important?
How common is back pain?
While the term back pain suggests a single problem, the causes of back pain are often broad and varied ranging from benign to malicious, mild to severe, short term to chronic. Understanding the likely cause for your backache will help you decide whether you need to take remedial action and if and when you should see a health professional.
A study published in the Journal of Spinal Disorders found that between 12% to 33% of the UK population have lower back pain this very moment and 22% to 65% will experience it this year.
The article, Prevalence of thoracic spine pain in a surveillance network, noted that one in 10 men and one in 5 women suffer from back pain in the middle and upper spine.
So, the moral of this story is please understand that back pain is a common complaint but it is never to be discounted as normal!
Why does backache occur?
Fundamentally the spine is made up of joints, muscles and nerves…. When placed under stress, the function of these composite pieces can be altered, inflammation & pain occurs as a prelude to injury, continued stress then will lead to chronic dysfunction, ‘wear & tear’ often then accompanies long term pain patterns.
Whilst it is often the desire of the patient to pinpoint a problem to an exact specified joint or tissue; the truth is it is impossible for any dysfunction in the spine to happen in isolation, Punjabi’s extensive work in this field proves that tissue damage is a vicious cycle, no matter which component first was damaged, the other two components are subsequently affected.
Types of pain/What has failed?
There are three main types of pain. These are Joint Pain, Muscle Pain & Nerve Pain.
Joint dysfunction, happens when any two bones in the body lose their ability to move properly including their soft tissue connections.
In the spine, this often centers around the facet joint but includes the cartilage, joint capsule, long and short ligaments, synovial fluid, and the intervertebral discs (IVDs). The IVDs connect one vertebra to the next. They provide strength, allow motion, and fight gravity to keep us upright, the facet joints are at the back of each vertebra and guide and limit motion.
At the base of the back, the sacrum connects to the pelvic on each side, creating the sacroiliac joints (SIJs). You can identify the SIJs by the two dimples at the top of your glutes.
Joint pain in the back can occur in single or multiple locations. As I mentioned it can range from minor or a mild ache however if left untended it can be so severe that walking and moving is difficult. Chiropractor’s like me have spent their entire careers specialising in the identification of dysfunctional joints by their loss of normal range of motion, localised inflammation, pinpoint tenderness, and accompanying nearby muscle spasm.
Muscle pain occurs when muscular tissue is stretched, torn, under increased tension, receives reduced blood flow, or, in the case of chronic conditions like fibromyalgia, is inflamed.
In the back there are small muscles that connect one vertebrae to the next called the multifidus muscles, acting to stabilise the spine one joint at a time. Then there are longer muscles that connect different parts of the back, supporting the spinal column and the rib cage (Erector Spinae). Finally, there are the muscles that move our torso and, in the case of our pelvis, are attached to and involved with movement of our legs. Also known as the Quadratus Lumborum (QL) & Glutes.
Muscle pain can be a shock… it’s onset may be sudden, accumulative, or have been present for an extended period of time when linked to chronic bad movement or posture. It can be described as an ache, tenderness to touch, pain during use, or be felt as an intense spasm.
The muscles of our spine are the scaffolding that holds the structure of our spine together, they also have a protective role, as when joint dysfunction occurs or nerves are irritated the muscles are subconsciously activated in order to protect the component parts.
Nerve pain is often quite dramatic and occurs when a nerve is traumatised in some way; for example, when a disc bulges or herniates and compresses its nearby nerve root. Sciatica is probably the best-known example of a nerve problem.
NHS England estimate that 95% of these sciatic nerve entrapments are due to disc damage, however it is also possible that nerves can be trapped in the extremities such as in the case of piriformis syndrome where the same sciatic nerve is crushed by a spastic muscle in the pelvis.
Nerve pain can also be exacerbated by or as a result of illnesses like pernicious anemia (vitamin B12 deficiency) or diabetes, something we call neuropathic pain or neuralgia and pain tends to be described as burning, sharp, stabbing, tingling or like an electric shock.
Neuropathic pain tends to be different from radicular pain in that it starts from the ground up unlike radicular pain which is most commonly described as flowing down from the spine.
While it sometimes can be mild in nature, nerve pain is more commonly severe and it can have significant impacts on quality of life… compromising a person’s ability to work, sleep, move and enjoy life. To complicate the scenario, it is almost always accompanied by a high level of muscle guarding making it difficult to differentiate between the preverbal chicken and egg.
So, the key clinical discussion becomes… How do you differentiate between mechanical (joint & muscle) irritation and disc-related nerve pain?
In truth these can appear identical, especially if the result is that the underlying nerve has been trapped or irritated. So, when you consult Proback Clinics our clinicians will take a history, perform orthopaedic and neurological testing, and often take further investigations such as x-rays. This will help to differentiate whether your pain is generated by mechanical dysfunction, nerve-related or directly from the disc itself.
Why does my leg/arm hurt?
When the pain is related to pressure on a specific spinal nerve, as can occur with a disc herniation, radiculopathies may result. This often presents as numbness, pain, pins and needles, or weakness along the distribution of that nerve.
Pain radiating down the arm can be a result of disc damage in the neck, yet in the lower back, sciatica with its associated pain down the back of the leg is a primary reported example of disc/nerve damage.
When dealing with leg pain the knee often becomes the key battle ground, if you have pain that exists in the hamstring or in the back of the knee, that doesn’t extend into the lower leg, it is unlikely sciatica is the cause and more commonly a local mechanical issue with the back or the knee.
When the lumbar nerves are involved, the pain often begins in the buttock (it is possible to have no pain in the back at all) extending down the back of the leg or jumping into the calf… the leg can feel weak and even give way as the nerves can also affect the muscle function… this is likely the infamous sciatica.
While uncommon, disc herniation in the thoracic spine can result in back pain in the middle that can extend via the nerves wrapping round to the front of the body. These exact symptoms do not occur in mechanical pain whose associated rib and muscle can be searing but localised.
NB: If you experience significant back pain in conjunction with weakness of muscles, loss of sensation, or pain in your leg or legs, recent bladder or bowel incontinence, numbness in your saddle area, or recent sexual dysfunction, head to A&E urgently. These are signs of cauda equina syndrome, which is a surgical emergency.
Frequently Asked Questions:
Is the location of my pain important?
In identifying the cause of your back pain, the first question to answer is:
Where is your pain? So yes, it’s important for us to differentiate between lower back, mid-back, and upper back, and pain that is located centrally, or to the left or the right.
Each section of the back can create local pain and inflammation when irritated but also it can refer pain too, each area has specific refer patterns for muscle (trigger point) pain or nerve referral patterns. Likewise, visceral pain, or pain referred from your organs is important to discount… your ProBack clinician is an expert in differentiating between these patterns.
Causes of lower back pain
With a lifetime prevalence of up to 84%, your chance of experiencing lower back pain (LBP) are high. LBP can be felt in the buttocks, pelvis or other areas from the base of the rib cage, downwards. Common causes include lumbar joint dysfunction, sacroiliac joint dysfunction, facet joint syndrome, degenerative disc disease, and less commonly, a herniated lumbar disc. Spinal canal stenosis, cancer, or infection are infrequent sources of backache.
At ProBack, we are experts at assessing, diagnosing and treating sources of lower back pain and referring you to the appropriate medical doctor in the unlikely event the pain is more concerning than initially thought.
NB: Tearing or ripping pain across the lower back is indicative of a potential Aortic Aneurysm tear, this high specific pain pattern is again a medical emergency and you should call an ambulance or head directly to A&E.
Causes of middle back pain
Back pain upper; that which affects the area above the lower back and below the neck, is less common than LBP. A study published in the prestigious journal Spine found a 17.0% one-year prevalence rate; that is, your chance of experiencing pain in this area over the next 12 months is just under one in six.
Often linked to the function of the shoulder blades and postural stresses, middle back pain; can result from poor posture and muscle strain or overuse. If you sit for long periods, spend ample time in front of a computer or television, or have a long commute, you are a risk. A fall or motor vehicle accident can result in thoracic fracture. Osteoarthritis, as with any region of the spine, can cause tenderness, pain, stiffness and limit range of motion.
There are also reasons for off-centre mid back pain. For example, right-sided back shoulder blade pain could indicate liver or gall bladder involvement, and left shoulder back pain might be a sign of a heart attack or a lung problem on that side.
Causes of back pain on the left side
Sometimes, back pain is limited to one side. Telling your Chiropractor exactly where it hurts, if you are able, will help reach a speedier diagnosis. Back pain in left side can indicate damage to left sided joints. For example, if there is a joint dysfunction involving the left sacroiliac joint, this is where tenderness will occur. This may explain back pain in lower left side.
Discomfort on the left side can also indicate the presence of organ involvement. When the pancreas is inflamed, pain may be felt on the back below the left ribcage. A left kidney infection may be experienced as a dull ache in the lower back of the same side and be associated with fever, nausea and pain on urination.
Causes of back pain on the right side
As with the left side, back pain in right side can indicate a musculoskeletal problem or underlying organ involvement. Back pain in lower right side can be related to the sacroiliac joint, a lumbar spine dysfunction, or local muscular spasm. Back pain right side is, in our experience, as common as lower left discomfort.
However, when discomfort strikes the base of the back on this side, it may also indicate visceral involvement. If you are female and also experience symptoms like heavy periods, soreness during sex, or infertility, back pain on lower right side might point to a non-musculoskeletal source like endometriosis or fibroids. Back pain lower right may also suggest a right kidney infection.
Is back pain a sign of early pregnancy?
A commonly asked question from sexually active women of reproductive age is: is back pain an early sign of pregnancy? Usually, the answer is no. While some report pain as early as the first month of gestation, most pregnant women don’t experience discomfort until several months along. We also get asked, is pregnancy a cause of back pain? To this, the answer is absolutely yes. The risk of back pain during pregnancy is a staggering 49%.
Why does back pain occur during pregnancy?
As a healthy pregnancy progresses, the foetus continues to grow. The increasing weight can, understandably, result in postural changes. The curve of the lumbar spine becomes exaggerated as a counterbalance to the expanding abdomen. The pressure inside the expectant mother’s uterus can push against and separate the rectus abdominis, or “tummy,” muscles and reduce the back’s anterior support. This can trigger lower back pain, which is often localised to the sacroiliac areas. A sedentary lifestyle also increases the risk.
According to the study Prevalence of back pain in pregnancy, “Back problems before pregnancy increased the risk of back pain, as did young age, multi-parity [being pregnant with more than one foetus at a time], and several physical and psychological work factors.”
Can back pain cause constipation?
Another question that we’re often asked is if back pain can trigger constipation. While the term back pain refers to a symptom, the underlying cause of backache might indeed cause constipation. Spinal joint dysfunction is known to cause back pain and adjusting these fixations may relieve constipation.
Case reports and series’ reported in the research article, What effect does chiropractic treatment have on gastrointestinal (GI) disorders: a narrative review of the literature, shows that constipation can be successfully treated with Chiropractic care, & on the flip side, constipation can also cause lower back pain.
Can back pain cause anxiety or depression?
While mainstream health readily places psychological and physical conditions in separate categories, they are intimately linked and, unsurprisingly, impact on one another. As the authors of study The Association of Depression and Anxiety with Pain: A Study from NESDA said, “Chronic pain is common in up to 70% of patients with depressive and anxiety disorders.” Unremitting pain most likely has a bidirectional association: significant discomfort creates or exacerbates mental illness and mental illness increases pain.
When is back pain serious?
Serious is a subjective term because if back pain is interfering with quality of life, it requires expert advice and care, but we’re regularly asked whether the discomfort a patient is experiencing could be cancer or result from another sinister origin. Firstly, most cases of back pain are musculoskeletal in nature and resolve with appropriate care. Secondly, the vast majority of backache does not have a malignant cause. That being said it’s important to look at those signs and symptoms which may indicate a serious underlying condition.
Is back pain a sign of cancer?
Sometimes, especially for our patients who have a family or personal history of malignancy, pain can trigger the natural worry, is back pain cancer? While the likely answer is no, these red flags indicate the need for concern and possible additional testing:
– Discomfort that is unrelieved by rest
– New pain in those under 20 or over 50 years of age
– Night pain
– Pain that is unresponsive to conservative treatment
– Persistent unexplained pain
– Prior personal history of cancer
– Unexplained weight loss
Chiropractors are thoroughly trained through years of formal and informal education to diagnose and treat back pain. While backache is of a mechanical nature in an estimated 97% of cases, other sources are ruled out during consultations and appropriate referrals can be made.
How do I find back pain relief?
Whether backache presents as an ache or stiffness, mild discomfort or sharp agonising irritation, our patients come to us for back pain relief. This is because we combine our years of experience diagnosing and treating back pain with state-of-the-art Chiropractic technology imported from around the world to offer the most advanced approach to spinal care available in the UK. We know what helps back pain.
At ProBack Clinics, we are highly trained to diagnose, treat and calm your back pain, naturally.
At every stage of treatment we also provide expert advice regarding appropriate rehabilitative exercises, nutrition to maximise repair and recovery.
Ergonomic advice… such as how to set up a desk, what mattress to choose and what is the best position to sleep in are all part of advice routinely handed out in our clinics.